The Failure Of Medical Missions

( Originally Published 1913 )

" We might be able to do a great deal of good in advancing the Gospel with inferior medical work, but we should aim at nothing less than the best professional results possible under the circumstances of our position. The best work secures the best results."

IT is not unlikely that there will be a good deal of astonishment as the title of this chapter is read. So much attention has been drawn on previous pages to the matchless opportunities and triumphant successes of Medical Missions that there would seem to be no room for even the thought of failure. And yet it is just the very sublimity of the enterprise and the insistent demand that it makes for adequacy and efficiency that constitute its elements of weakness and causes of failure. Not that Medical Missions are failing to achieve in large measure what has been claimed for them, but that the development which is essential to their truest success is being so curtailed, so cribbed, cabined and confined, so lacking in sufficient support, that instead of the best we have only the good, and in place of the complete we have only the partial.

And it is of imperative importance that due and instant recognition be taken of this fact. To go on, as much of Medical Mission work is proceeding today faced with unrivalled opportunities, stimulated with the desire to attempt the impossible, stretching always and ever the " thin red line " until there is never a second to fall back upon for reinforcements, will inevitably yield a harvest of failure, and water down the results of the enterprise until they are hardly worth the having. It is time, high time, that we paused deliberately to consider what are those factors in the present situation which are sources of inefficiency, and those alterations which should be made in Medical Mission procedure so as to turn the prognostications of failure into the heralds of success. We therefore invite careful attention to the following six contributory causes of failure in the life history of Medical Missions.

1. Insufficiency of the medical and nursing staff at any mission hospital.—At the special Medical Conference held at Edinburgh in 1910 in connection with the World Missionary Conference, the following resolution was unanimously adopted.:

" That Medical Missions should be continued and extended and that they should be under the charge of fully qualified medical missionaries, with properly staffed and equipped hospitals, and, where possible, European or American missionary nurses, to supervise the native staff of nurses."

At the same Conference the following " finding " of the Medical Missionary Association of India, was presented by Dr W. T. Wanless, of Miraj :

" That, in view of the desirability of providing for furlough and vacation without closing hospitals which have once been established, and in view, also of the great responsibility entailed by serious operations, the necessity of having two fully qualified doctors on the regular staff of each Medical Mission station should be urged upon the Home Committees and Boards, especially in the case of Women's Missions."

These strong and influential opinions, which medical missionaries all over the world heartily endorse, reveal how important is the question that we are now considering. But even apart from such " findings " it will, we think, be apparent to all students of the subject that an insufficient staff must spell inefficiency.

Think for a moment of the kind of work that has to be carried on in mission hospitals. Its scope includes not just a few subsidiary branches of medical and surgical science, but again and again is found to embrace cases that here at home would be deemed fit patients for a dozen and more special hospitals. The medical missionary has to be physician, surgeon. and specialist all at the same time, and has, in addition, to cope with the yet unworked out science of many a perplexing tropical disease. He has to perform many a grave surgical operation, and to treat affections, in which the utmost professional skill is required. Moreover, an ever present consideration is the fact that mistakes, if they are committed, mean very frequently far more than they do at home. Here they are understood and occasion, except in rare instances, no weakening of confidence. There the failure to achieve what was hoped for by an operation, or some error of judgment very difficult to prevent, may exert a most adverse influence upon the work of the mission. It is therefore of supreme importance that the work of a hospital should be as free as possible from avoidable failures in treatment.

Now all this means that there is a big strain continually resting upon the medical missionary in charge of a hospital, and that there is a clear call for him or her not to be without a medical colleague whose aid can be quickly obtained. Two doctors should certainly be deemed essential, and very frequently a nurse, if there is to be a proper safeguard placed against both the occurrence of failures in practice and an overwrought and broken down state on the part of the one doctor left in charge. It may, of course, be perfectly legitimate, and indeed the only possible course for but one doctor to be in charge of a Medical Mission centre during its initial stage, but once let that period be passed, and the red light of the danger signal shines in front, should there be any delay in adding the second doctor, and, especially in the case of women's hospitals, a trained nurse.

Furthermore, there are yet two additional considerations which plainly point out the seriousness of an insufficient staff. The first of these is the necessity of providing for the hospital during the period of absence caused by itinerating tours. Obviously unless there be a second doctor who can remain in charge, either the hospital must be left without a doctor, or the itinerating tours, useful as they are, must be given up. We are aware that trained native assistants have rendered, and can render great service under such circumstances. Not for a moment would we overlook their valued help. But it must be remembered that as yet these native helpers are not, as a general rule, of such a sufficiently advanced grade as to be able easily to assume responsible control of a hospital for any considerable length of time, without the presence of a European medical missionary. The day will come, and every friend of the work will hail its advent, when fully qualified native colleagues will be able to effectively take over the work of mission hospitals, but for the present it would be premature to argue that because of the presence of native assistants, two doctors are not a necessity at these institutions.

Then there is the second consideration, that of furlough exigencies. Who has not read in the records of societies again and again that because of the absence of the medical missionary on furlough, such and such a hospital had to be closed. Work that was far-reaching in its influence, and from every point of view most necessary, absolutely stopped, and to that extent its power lost, all because no second doctor was at hand to step into the breach when the first went on furlough. The pathos of such a situation is closely bordering on tragedy. Who can think of it unmoved ? Can there be the smallest doubt that the only way to prevent a great leakage of influence is to staff our mission hospitals sufficiently strongly that when one doctor leaves, another takes his place ?

2. Inadequacy of medical plant.—We now touch one of the most fruitful causes occasioning the set back of many a promising Medical Mission centre. And it is certainly one of the most disappointing. For if a medical missionary, fully trained and eager to accomplish the best work, has been accepted and sent out, what could be more calculated to nullify his efforts and limit his possibilities than to utterly fail to provide that degree of equipment which is essential for efficient medical work ?

We do not, of course, refer here to what may be described as purely optional, or to any of the refinements of modem therapeutic science, however useful and legitimate such may be, but simply to those items in the equipment of a Medical Mission which are indispensable to success. For example, can there be any question as to the necessity for an adequate supply of drugs and instruments ? Yet there have been, and there may be still, medical missionaries who have actually had to wait in vain for these things. Or again, is it possible to entertain the smallest doubt as to the call for a hospital into which patients can be taken, and surgical work undertaken with sufficient regard to necessary precautions ? Yet how many medical missionaries to-day are devoid of a hospital unless it be some feeble makeshift of one which the doctor may have tried to make out of unsuitable native dwellings. The day may have passed when the popular conception of a medical missionary was a man who went out with a box of pills and ointment in his bag, but it is to be feared that there is still a very inadequate idea as to the essential equipment that he requires. To remove that view and implant the correct one should be there-for the constant aim of those who wish to hasten the success and prevent the failure of Medical Missions.

3. Wastage of evangelistic opportunities.—The primary aim of all medical missionary enterprise, as we have been already reminded, is to further the spread of the Gospel. For that great end this branch of Christian missions acknowledges its dominant raison d'être. It therefore follows that if there is any leakage of spiritual results, any neglect in seizing and following up the unique advantages that Medical Missions present for bringing home to the hearts of men and women the truth of the Gospel, just in so far is there the sign of failure written across the work. Here, if anywhere, must Medical Missions be subjected to the most searching scrutiny.

Now, when thus we look into the day by day experience of medical stations, we find that there is considerable ground for disquietude on this score. Our medical missionaries are toiling with unremitting ardour. They are winning opportunity after opportunity for evangelising the people. But, alas that we have to say it, these very openings, through sheer lack of time, and because of the fewness of the labourers and the greatness of the task, are at the best only being utilised at a fraction of their possible value.

Let us quote from a most important pamphlet, entitled " Where Medical Missions fail," which was written by Dr Harold Balme, of China, a few years ago. Alluding to the point we have just touched upon, he writes :

" This is no fancy. picture. During the past year I have had an opportunity of visiting fourteen Medical Missions, and of conversing with representatives of three or four others, and it has been only too obvious how real a danger this is everywhere. In many cases the doctor finds his time wholly taken up with the hundred and one details which crowd into each day's work (his native helpers often enough being too few or too slack to render very efficient help), so that the result is that with the exception of an occasional, and possibly more or less perfunctory service, the new patient, whose friendliness and confidence have already been won by the medical skill and kindness received in the wards, never gets into real touch with that ` Jesus ' whose name the hospital bears, and so far from receiving the revelation of God's love into his heart, he goes back to his home but little better than when he came. And yet all that time, there has been daily in the wards one of the finest congregations which a missionary could ever hope for—men from all parts of the country, and new to the Gospel ; men with plenty of leisure to listen, and free from distraction ; and lastly, and best of all, men who have already begun to respond in some little way to the kindness they have been receiving. And the precious opportunity passes because there is no one to take advantage of it.

Proceeding further, Dr Balme discusses the question as it affects the villages and writes :

" Again, let us take the case of our own hospital. In the course of a year our beds are occupied by scores of men who have never before heard the message of salvation. They come to us, many of them, from places far distant, drawn by the simple fact that some relative or friend, or somebody in the neighbouring village, has been cured at the hospital, and in this way they too get emboldened to try the risky experiment. Thus it comes to pass that many of them, on arriving, are as strange to us and our doings as they are to the Gospel we preach. But a few days' residence in the wards, and the strangeness wears off, and as, by God's blessing, their bodily condition begins to improve, their minds and hearts begin to open to that message which is daily unfolded to them ; and, in many instances, when the day comes for them to leave the hospital, they not only have become our friends, but have also begun to take a real interest in the old, old story.

" So far, so good—but what then ? In our own case we have at present sorrowfully to admit that the great proportion then go entirely out of the sphere of missionary influence. They return to villages where no mission work exists, and in the present state of our work we are quite unable to follow up what has been begun.

" What does this really signify ? Surely if it means anything at all it means just this—that the unique advantages which are thus being won by the hospital, at the cost of so much money and time and strength, are being dropped just as they are in one's grasp, and that whereas our Medical Mission work is being blessed by God to open up village after village, the doors thus opened are allowed to creak slowly back upon their hinges for want of anyone to enter."

Now, it is impossible for anyone to read these words without feeling how serious is this wastage of evangelistic opportunities. We are faced here with a matter which cuts at the very root of the spiritual efficiency of Medical Missions. And unless there can be found and adopted some means of checking the leakage, it will be idle for us to go on speaking of Medical Missions as a great evangelistic success. Obviously there is abundant need for the most earnest prayer and deliberate thinking concerning this aspect of our subject.

In the pamphlet by Dr Balme, from which we have already quoted, he gives two suggestions for solving the problem. The first is the obvious one to so " staff the hospitals as to enable each medical missionary to spend a fair proportion of his day in direct personal evangelistic work in the wards, and also to allow of one doctor being set free, every now and again, to make itinerating journeys into the country district, partly with the object of doing medical evangelistic work, but more especially for the purpose of looking up old patients and continuing the teaching which has been started in the wards."

The second suggestion is that every mission hospital should have added to its staff one non-medical missionary, whose whole time should be devoted to evangelistic work amongst the patients, both while they are in the hospital, and afterwards when they have returned to their homes.

The appropriate and apposite character of both these suggestions will appeal to all. They include within themselves the most cogent remedies for the failure we are now considering. Needless to say, if there were enough medical missionaries available, the first suggestion is the best line to adopt, and it should in any case represent the definite aim of every Medical Mission Committee. But in view of the all too inadequate number of men and women medicals now coming forward for this work, it would seem most emphatically that there is very ample room for Dr Balme's second suggestion. Such a non-medical missionary would find abundant scope for his time and energy. He would reach a wonderfully prepared set of people, and his work would enhance, in a very clear and definite way, the spiritual efficiency of the hospital. We believe already that the suggestion has been put in force in the experience of some Medical Missions, and has proved its value. As an instance of this may be cited, a case mentioned by Dr Balme, of a Wesleyan Missionary who was attached to a station in India, where his sister was a lady medical missionary. By following up her old patients he had in seventeen years obtained an entrance to 100 villages, and baptised upwards of 3000 people. Why might not the results of many other Medical Missions be multiplied in a similar way ?

4. Opening too many medical stations.—It may be difficult at first to see why this should be reckoned amongst the causes of failure in Medical Missions. After all that has been said as to the need for medical missionaries, how can there be " too many " medical stations ? And yet it is true, only too easily, that the multiplying of medical centres introduces a positive weakness into the work instead of a blessing. The line is thinned out until at no point is its effectiveness what it should be. Important base hospitals are depleted to open advance outposts, with the result that the efficiency of the former is imperilled, and the work of the latter insufficiently supported, and liable at any moment to complete arrest. True, we cannot remain just where we started and never advance, nor can there always be the avoidance of times of strain when new medical stations are commenced, but it is surely of the greatest importance that there should not be the opening up of such a number of separate Medical Missions as must necessarily involve the unhappy results above mentioned. May it not be serving the cause best to maintain only that chain of stations which can be effectively sustained ?

In this connection we would draw attention to the immense importance of exercising the utmost discrimination in selecting hospital centres. Too often, it is to be feared, mission hospitals have been established in places which, whilst no doubt presenting distinct need, are not those from which large populations can be reached. The consequences are two-fold. Firstly, these hospitals and those in charge of them are denied that scope for which they have potentiality : they are limited in their range of opportunity. Secondly, the existence of hospitals in such places often prejudices the establishment of hospitals in other centres where the degree of utility attained would be so much greater. Not for a moment would we wish to decry any really needy mission station having a hospital. On the contrary we would hail the day when mission hospitals should be established in every part of the field. But, bearing in mind the present limitation of mission resources, and having regard to the immensity of the area yet unoccupied by mission hospitals, teeming as it does with unique opportunities for their peculiar service, it would seem to us the highest wisdom and truest success to plant these valuable and costly institutions in those centres only where their amplest possibilities for accomplishing the end in view can be utilised to the full.

5. Designating new medical missionaries to responsible medical positions before their probationary period has been passed.—Scarcely is there anything more calculated to injuriously affect the entire career of a medical missionary, than the step of sending the new doctor to stations where he or she will be the only doctor, or placing the probationer in positions where medical work will press heavily before the language examinations have been satisfactorily passed. It has been the reproach sometimes cast against Medical Missions that so few of the doctors are good linguists, but how much of this has not been occasioned by the practice of sending new medical missionaries right into positions where they have had to undertake a large amount of medical work before their study of the language was surmounted ? It is the peculiarity of Medical Missions that its workers can undertake their work, and are often pressed to do so, by requests which they cannot withstand when they are alone, before they have been in the country many days ! Therein they differ from their evangelistic or educational colleagues. How important, therefore, that they should not be put into places where this fatal ability, to instantly engage in work, becomes a curse and not a blessing, when viewed from the standpoint of their life work as missionaries. Can it be questioned that the medical missionary's period of probation on the field should be concentrated upon two main things : (1) getting to know the people and their customs, (2) acquiring the language ?

We do not, of course, mean by this that the new doctor should never see or assist in any medical work.

It is obvious that a course like that would tend to his or her becoming seriously " rusty " ; moreover, by mixing with dispensary and hospital patients, the doctor will be greatly helped in obtaining the language. But this is naturally quite different to the medical missionary having to assume charge of any medical work, and thereby quickly becoming submerged under its claims.

Clearly the logical and correct plan is to place the young medical missionary where there is at least one other senior doctor, whose work he can watch, without at the same time finding his language study pushed into the background. May the day soon come when no medical probationer will have his early days on the field spent in a different manner ! So will the efficiency of the whole work be promoted, and a cause of failure removed.

6. Sending out new medical missionaries without a sufficient amount of post-graduate work.—This point, like the last, is of primary importance as touching the personal equation in the work. And it is one which is all too apt to be lost sight of by " lay " committees and those not connnected with medical science. The appeals from the field are so urgent, the paucity of workers is so great, that the temptation to urge the going out of medical candidates as soon as they are qualified becomes well nigh irresistible. But it must be resisted, and with stedfastness, or a grave injury will be done to both the workers and the cause.

For let it be remembered that the recently " qualified " medical, as every one in the profession knows, is but a " tyro " in medical practice. He may possess an almost encyclopaedic knowledge of medical text-books, and be able to produce a faultless record of his student career, but he is, at the best, only a "'prentice hand."

He has indeed merely come to the point when the school of theory has to be exchanged for the school of experience. And if his beginnings in that latter school have to be worked out far from masters, who are themselves but senior students in the same school, and under circumstances where he is thrown upon his own resources, and has at the same time to acquire a new language, how tremendously increased are his difficulties, and how great is the risk that the new medical missionary will suffer a heavy disadvantage in his professional work from then right onwards.

Furthermore, it is important that due recognition should be given to the fact which already has been emphasised, viz., that the medical missionary needs to be a specialist rather than a general practitioner. He has to be prepared to meet and treat grave medical and surgical affections, which will test his professional acumen to the full. He has to put up his door-plate, so to speak, where there is no " Harley Street " to call in, and where great issues, missionary as well as medical, may sometimes hang upon his practice. Is it possible therefore, to question for one moment the vital importance of a sufficiency of post-graduate work ere the young medical missionary sails for the field ?

It will be our object in a subsequent chapter to discuss the kind of post-graduate work that should be carried through, and we therefore content ourselves here by saying that above all it should be practical, and cover a period of at least eighteen months, its great aim being to develop self-reliance of the right sort. With great earnestness would we venture to urge attention to this matter. It bears a most essential relationship to the success of Medical Missions, and if neglected or slurred over, may be one of the most prolific causes of failure in the enterprise.

We have thus enumerated some of the main factors that go to lessen the value and undermine the utility of Medical Missions. They are not all that might be mentioned, but they will sufficiently indicate how necessary it is that thoroughness and efficiency should characterise every aspect of the work. Apart from these. qualities, Medical Missions, we say it advisedly, will not pay. Of all forms of missionary activity, they supremely require to be done well. Moreover, there is this consideration, which surely ought to carry with it the most solemn right. Medical Missions own their descent and authority from our Lord Himself. His is the sacred Person who constitutes their lofty Ideal. His is the name in whom their service is rendered. And He gave that which was His best. He spared no pains to accomplish His blessed work. Should His followers do less ?